Lecture 12 - Medicines Care Review Flashcards
Why was medicines care review introduced?
to make better use of pharmacists’ skills to improve patient care
combined serial dispensing and pharmaceutical care model schemes
joint working between GPs and community pharmacists
How is there joint work between GPs and community pharmacists?
identifying and prioritising risk from medicines
minimising ADRs
address existing and prevent potential problems with medicines
provide structured follow up and interventions where necessary
Why do we need to manage the workload?
More Rxs dispensed year on year
What is MCR?
Pharmaceutical care planning in the community pharmacy setting
a system of formalising the contribution to care that pharmacists deliver
What does MCR add to?
the value of our contribution and documents what we have been doing for years
Drivers for MCR?
prescribing
dispensing
compliance/concordance
workload
Prescribing error rate?
7.5%
Dispensing error rate?
3.3% of all items
Non adherence rate?
30-50%
Hospital admissions due to ADR?
2.7-6.5%
CMS - why do we do it?
improve clinical outcomes (actual and potential drug related outcomes)
improve concordance
reduce ADRs
promote self care
reduce rates of readmission to hospital
reduce wastage
patient safety
Why the pharmacist?
Ideally placed to have regular contact with the patient
- patients like time with the pharmacist
- ease of access due to longer opening hours and locations
highly skilled in use of medication
good communication skills
How much income does CMS generate?
19% of income, 38% from dispensing
How do pharmacies get money from CMS?
each pharmacy has a target number of patients to look after based on the number of patients they service - meet or go above target to make money
Which patients?
targeted to patients that need it (quality not quantity)
have one or more LTC that requires medication e.g. asthma, CHS, diabetes
new medications
high risk meds (warfarin, methotrexate, lithium)
smoking cessation
gluten free foods annual health check
Patient Eligibility for CMS?
all patients with a long term condition are eligible
all registered patients are eligible to receive pharmaceutical care package from pharmacist
What patients are NOT suitable for a serial script?
drugs subject to dose titrations
patients subject to frequent medication changes/hospital admissions
controlled drugs (2-4) and cytotoxics (methotrexate_
drugs needing close monitoring may/may not be suitable
What is stage 1?
registering the patient
What does registration include?
patient registers with pharmacy of their choice (one pharmacy)
underpinned by explicit patient consent - must be explained to the patient at the time of registration
selection must be done either directly or under the supervision of a pharmacist
What is registration done via?
the patient registration system (PRS) hosted at the national services scotland (NSS)
Eligibility for registration?
patient must be registered with a scottish GP practice
patient must have long term conditions
not a resident in a care home (nursing or residential)
Data required to register a patient?
name, gender, address including postcode, date of birth, exemption status, community healthy index (CHI) number
What is generated during registration?
paper registration form which is signed by both patient and pharmacist
What does the GP receive?
an electronic registration notification message ONLY if patient is exempt from prescription charges on age or medical grounds
Withdrawal from CMS?
can be done under patients choice, if they are not eligible anymore and if they register at a new pharmacy
What is stage 2?
Pharmaceutical care planning
When must stage 2 be undertaken by?
within 12 weeks of registration
Who needs to do the pharmaceutical care planning?
the pharmacist
priorities assigned to help pharmacist target patients in most need of support
patients and pharmacist discussion to agree outcomes
What happens during pharmaceutical care planning?
identify actual and potential problems
document issue/action/outcome
monitor, review and update the care plan
may involve other healthcare professionals (BP check or biochemical test)
link to patients PMR (must be documented)
what must be completed to receive payment?
stage 1 and stage 2
What does the patient profile include?
general health, medical conditions, allergies and sensitivities, patient factors, care plan priority
What is the medication profile?
questionnaire on the patients medicines based on yes or no questions
What is the pharmaceutical care plan?
documents the care issues, desired outcomes and the actions
helps to monitor, review and update progress against the agreed actions
What is stage 3?
serial dispensing
Who is the decision for serial dispensing made by?
GP or the pharmacy
depends on the healthy board
How many weeks at a time can be prescribed?
24, 48 or 56 weeks, dispensed at time intervals determined by the GP
What happens if someone required medication early (e.g. for a holiday)?
can be dispensed at pharmacists discretion
What does disease specific control determine?
referral criteria and reporting requirements as well as specific pharmacy care issues for that condition
What happens during serial dispensing?
pharmacist downloads electronic version of the serial prescription prior to dispensing to ensure working on most recent e version
e claim send and e message to GP
should be convenient to GP but underestimates how erratic patients are
What works well for serial prescribing?
choosing the correct patients - patient education is key!
What medication needs to be added to a serial prescription?
ALL or nothing to start, can progress to prn
What is important for serial prescribing?
all prescribers known how to make changes to the script and communicate this change
knowing when patient is no longer suitable
communication between practice and community pharmacy
Benefits to practice of SRx?
manages increasing workload
SRx already in some area
reduces repeat prescribing in GP practice
supports patients
increased direct contact with patients with trained HC professional
pharmaceutical care delivery
> 100 SRx in CP will ensure it becomes normal pratice
8-10% of practice list size then begin to see impact on workload
